Effect of surgical training course on performance of minor surgical procedures in family medicine physicians' offices: an observational study

Abstract

Aim: To examine the influence of a practical surgical course on the number of minor surgical procedures performed by family physicians.

Methods: We compared the number of minor surgical procedures performed by family physicians in 59 offices in the city of Osijek and surrounding rural area during 12 months before and after the 40-hour practical surgical course held in September 2006 by surgeons and family medicine specialists. Minor surgical procedures taught in the course included management of ingrown toenails, abscesses/comedones, and minor wounds, anesthesia application, disinfection, use and sterilization of surgical instruments, and antibiotic treatment.

Results: The number of minor surgical procedures performed in family medicine offices almost doubled (503 vs 906 after the course, P<0.001, Wilcoxon test). The median number of abscesses/comedones treatments per physician increased from 1 to 6 (P<0.001, Wilcoxon test), the number of managed wounds increased from 111 to 217 (P<0.001, Wilcoxon test). The increase in ingrown toenail resections was also significant (from 120 to 186, P=0.004, Wilcoxon test). Fifty percent of physicians did not treat patients surgically, irrespective of the training. We found no association between the number of performed procedures and age, length of employment, or location of the physician's office (urban vs rural). However, we found that male physicians performed more surgical treatments both before and after the course (abscesses/comedones: P<0.001 and P=0.108 respectively; ingrown toenail resections: P=0.008 and P=0.008 respectively; minor wounds: P=0.030 and P<0.001; respectively).

Conclusion: Practical courses can encourage practitioners to treat the patients surgically in their offices and, thus, increase the number of services offered in primary care. Female physicians should be more encouraged to perform minor surgical procedures in their offices.

Figure 1

Total length of employment compared with the length of employment as family physicians of 59 family physicians enrolled in the study on the number of minor surgical procedures performed in their offices before and after the surgical practical course on minor surgical procedures in family practitioner’s office. The 40-hour mixed theoretical/practical course was organized as a part of continuous medical education of medical doctors according to the rules and normative of Croatian Medical Chamber.